Evaluation of a tuberculous abscess on the right side of the diaphragm with contrast-enhanced computed tomography: A case report

Abstract

Abstract.We herein investigate the case of a patient with a tuberculous diaphragmatic abscess confirmed by pathology. The patient underwent plain computed tomography (CT) examination of the chest and contrast-enhanced abdominal CT examination. The abscess appeared as hypodense mass with thick and irregular wall, which was enhanced on the contrast-enhanced CT images. The shape of the mass resembled an irregular double convex lens. No enlarged lymph nodes were detected on the CT images. The presence of a tuberculous diaphragmatic abscess should be suspected in patients with a diaphragmatic hypodense mass with enhanced thick walls, even when there is absence of enlarged lymph nodes on the CT images.

Surgical resection of a tuberculoma in the diaphragm: a case report

“…Including the present case, four cases involving treatment of a tuberculoma in the diaphragm have been reported [2][3][4]. The patients required surgical resection in all cases, although ATT was preoperatively performed in two cases.…”

“…We have herein reported a rare case of a tuberculoma in the diaphragm. Extrapulmonary tuberculosis in the muscles is very rare, with an incidence rate of 0.015% [2], and only a few cases of extrapulmonary tuberculosis in the diaphragm have been published (Table 1) [2][3][4]. Cold abscesses are defined abscesses that lack acute inflammation signs, such as pain, erythema, heat, swelling and immobility [5].…”

“…Diaphragmatic tumors are difficult to diagnose by noninvasive approaches, such as CT and ultrasonography [4]. In addition, two previously described patients had no tuberculous lesions in the bilateral lung fields; thus, a definitive diagnosis of a tuberculous abscess was difficult to attain preoperatively [3,4].…”

“…Possible mechanisms underlying the development of tuberculosis in the chest wall include spread via the lymphatics, spread via the bloodstream, and dissemination from the lung to the thoracic space [10]. Peng et al [3] suggested that hematogenous dissemination was the route of spread leading to a tuberculous abscess in the diaphragm. In our patient, pathologic examination revealed lung tissue with multinucleated giant cells adhered to the wall of the tuberculosis lesions in both the diaphragm and posterior mediastinum (Fig.…”

“…Tuberculous infection in the muscle is extremely rare, occurring in about 0.015% of all patients with tuberculosis [2]. Moreover, a few cases of tuberculous infection in the diaphragm have been reported [2][3][4]. We herein report a case of tuberculomas in the diaphragm and posterior mediastinum that were successfully diagnosed and treated.…”